Volunteer Registration Packet THANK YOU for your interest in becoming a partner/volunteer with the Boys & Girls Clubs of Martin County! We look forward to learning more about you and feel confident that this will be a rewarding experience for both you and the youth we serve. The process for becoming an approved Partner/Volunteer is as follows:

1. Complete the partner/volunteer registration form.

2. Read and sign the confidentiality form.

3. Read and sign the waiver agreement and statement.

4. Complete the background screen request form.

5. Read and sign the clearinghouse privacy policy form.

6. Turn in all completed forms in one of the following ways:

- Drop off to the Administrative Office in Hobe Sound (11500 SE Lares Ave) - Email to LGormley@bgcmartin.org - Fax to 772-545-1204 - Mail to: Boys & Girls Clubs of Martin County

Attn: Lindsay Gormley P.O. Box 910 Hobe Sound FL 33455

Completion of a level II background screen is required of all volunteers, partners and employees. Upon receipt of the above forms you will be sent specific information on where fingerprints can be completed. Once approved, you will be notified and invited to a volunteer orientation.

VOLUNTEER REGISTRATION FORM

Please PRINT all information clearly. Last Name

First Name Middle Name

Current Address:

Street City State Zip Code

Other Address:

Street City State Zip Code

Home Telephone Number Cell Phone Number Email address

Current Employer or former employer, if retired* _______________________

Work Number __________________

Education Level High School College Graduate School Other

*Many employers provide grants to non-profits for employee and retirees volunteer hours

Previous/current volunteer experience

Special Skills/Hobbies/Interests

Referral Source

Reference (#1) Name: Phone #: Reference (#2) Name: Phone #:

Business: Years Known: Business: Years Known:

___ Full-time Resident OR ___ Seasonal Resident __________________________________________

Which months are you in Florida? Please check where you would like to volunteer

□ Stuart Branch 1300 SE 10th Street Stuart, Florida 34994 (772) 888-9070

□Bill and Barbara Whitman Branch Indiantown 17375 SW Palm Beach Street Indiantown, Florida 34996 (772) 597-5088

□Cole-Clark Branch Hobe Sound 11500 SE Lares Avenue Hobe Sound, Florida 33455 (772) 545-0054

□H. Wayne Huizenga Branch Palm City 1150 SW Martin Downs Boulevard Palm City, Florida 34990 (772) 220-9160

□John & Marge Bolton Branch Port Salerno 4731 SE Flounder Avenue Stuart, Florida 34997 (772) 283-5900

□Administrative Office Hobe Sound 11500 SE Lares Avenue Hobe Sound, Florida 33455 (772) 545-1255

VOLUNTEER AVAILABILITY: Club hours for our after-school program are 2:30 PM to 6:30 PM Monday through Friday. During summer and non school days our hours are 7:30 AM to 5:30 PM. Please check the days that you are available and indicate times (for example: Monday from 10AM to 1PM).

Choose the age group(s) in which you are interested: 6 to 8 9 to 11 12 & older No Preference Please list any specific volunteer areas of interest under the following categories:

I CERTIFY THAT ALL STATEMENTS ON THIS APPLICATION ARE TRUE AND HEREBY AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I FURTHER UNDERSTAND THAT VOLUNTEERING WILL BE CONDITIONAL UPON INITIAL AND CONTINUAL SATISFACTORY BACKGROUND SCREEN RESULTS.

Signature of Applicant Date ________________________

If you are able to help cover any of the $71 background screening fee,

Donations are gratefully accepted:

___ Attached is a check for $ _________ to help cover the background screening fees.

___ I am sending my registration forms electronically and will mail a check for $ _________

Make check payable to Boys & Girls Clubs of Martin Co

Please add to memo line: Background screening donation Mail to: BGCMC, P.O. Box 910, Hobe Sound, FL 33475

Attn: Volunteer Department

Monday Tuesday Wednesday Thursday Friday Weekend Events

Education Arts Sports Recreation Office/Clerical

Tell us about yourself:

What experience do you have in related areas?

CONFIDENTIALITY AND NON-DISPARAGEMENT AGREEMENT FOR VOLUNTEERS (4 Pages)

The purpose of this Confidentiality and Non-Disparagement Agreement (this "Agreement") is to set forth the understanding of the Volunteers of the Boys & Girls Clubs of Martin County, Inc. (the "Clubs") with respect to confidentiality of activities, materials and information from the Clubs.

I, ___________________________(Volunteer Name), enter into this Agreement as of _____________, 2016. My consideration for entering into this Agreement is my volunteerism or continued volunteerism with the Clubs.

1. I Will Maintain the Confidentiality of Confidential Information. A. Confidential Information. In the course of my volunteerism with the Clubs, I may have access

to, be trusted or become acquainted with, and/or may acquire, knowledge of various confidential, trade secret and/or proprietary information of the Clubs that is of a personal nature to the Clubs' clients or that provides the Clubs or its clients with a competitive advantage (or that could be used to the Clubs’ disadvantage by a competitor), that is not generally known by people not employed or associated with the Clubs and that could not easily be learned or determined by someone outside the Clubs (collectively, “Confidential Information”). Confidential Information includes, but is not limited to, all non-public information whatever its nature and form and whether obtained orally, by observation, from written materials or any other media, including, but not limited to, human resource information, payroll, donor information and identities, technical data, know-how, research, business practices, agreement terms, services, employees, volunteers, Directors, suppliers, clients, technology or other strategic partners, markets, software, developments, processes, marketing, finances, notes, analyses or studies and all tangible and intangible embodiments thereof of any kind whatsoever.

B. My Use of Confidential Information. During my volunteerism with the Clubs, and at all times thereafter, I shall not in any manner, either directly or indirectly, (1) use any part of the Confidential Information except to provide services to the Clubs, or (2) divulge, disclose, distribute, reproduce or communicate to any person or organization any of the Confidential Information without the prior written consent of the Clubs; provided, however, that I may disclose the Confidential Information as may be required by law or court process, provided that I provide the Clubs reasonable prior notice to allow the Clubs sufficient time to obtain a protective order to prevent disclosure of the Confidential Information, or take other appropriate action.

C. I will Protect the Confidential Information. I will take all steps reasonably necessary and/or requested by the Clubs to ensure that the Confidential Information is kept confidential pursuant to this Agreement. I will comply with all applicable published and communicated policies, procedures and practices that the Clubs has established and may establish from time to time with regard to the Confidential Information. I will not, directly or indirectly, reproduce, permit reproduction of, remove and/or permit removal from the Clubs’ premises of, any Confidential Information, except as necessary within the scope of my volunteerism with the Clubs.

D. The Clubs Owns the Confidential Information. I acknowledge and agree that the Confidential Information, and all copies and manifestations of the same, are, and shall remain at all times, the exclusive property of the Clubs and/or its clients and clients.

E. I Acknowledge the Value of the Confidential Information. I acknowledge and agree that the Confidential Information is a special and unique asset of the Clubs, created and/or obtained by the Clubs at time

and/or expense, from which the Clubs may or do derive independent economic value from the Confidential Information not being generally known to third parties.

F. My Return of Confidential Information and Other Property. I will, immediately upon the Clubs’ request, and immediately upon termination of my volunteerism with the Clubs, for any reason or for no reason (and regardless of who is the terminating party), return to the Clubs: (i) all copies and manifestations of Confidential Information that I may have or have access to; (ii) all documents, other materials and equipment provided by the Clubs; and (iii) all documents and materials that I have prepared during my volunteerism with the Clubs.

G. Notice to My Future Volunteer Agencies. Following the termination of my volunteerism with the Clubs, for any reason or for no reason (and regardless of who is the terminating party), the Clubs shall have the right to: (i) inform each of my future volunteer agencies and engagees in writing of the existence of this Agreement and (ii) provide such volunteer agencies and engagees with a copy of this Agreement.

2. Non-Disparagement. At all times following the execution of this Agreement, I agree to refrain from communicating with third parties in any manner whatsoever that is detrimental to the interests of the Clubs or disparaging the Clubs and its services, employees, volunteers, Directors, suppliers or clients to third parties in any utterance, writing, or other form of communication to communicate with reference to the Clubs only in truthful, favorable and respectful terms.

3. I Have No Other Conflicting Obligations. I hereby represent, warrant and covenant to the Clubs that I am not bound, nor will I become bound, by any contract, agreement, covenant or other obligation that may or does prevent me in any manner from performing pursuant to this Agreement. I have not and shall not, at any time, improperly use or disclose any proprietary information or trade secrets of any former or current employer or other person or entity with which I have any agreement or duty to keep in confidence information acquired by me, if any. I shall not bring onto the Clubs’ premises any unpublished document or proprietary information belonging to such employer, person or entity unless consented to in writing by such employer, person or entity. I represent and warrant to the Clubs that the Results (as defined below) or any part thereof does not and will not infringe any patent rights, copyright, trade secret right, or other proprietary right of any third party.

4. Enforcement Costs and Fees. I agree if any legal proceedings are brought for the enforcement of this Agreement, in addition to any other relief to which the successful or prevailing party may be entitled, the successful or prevailing party will be entitled to recover attorneys’ fees, investigative fees, administrative fees billed by such party’s attorneys, court costs and all expenses, including, without limitation, all fees, taxes, costs and expenses incident to arbitration, appellate, and post-judgment proceedings, incurred by the successful or prevailing party in that action or proceeding. Solely for purposes of determining whether I or the Clubs will be responsible for paying such amounts, I agree that the Clubs shall be deemed the prevailing party in any suit, action or legal proceeding in which the Clubs proves by a preponderance of evidence that I have either: (A) violated, breached, or threatened to breach this Agreement; and/or (B) retained any of the property which I am required by this Agreement to return to the Clubs.

5. Certain Legal Effects of this Agreement.

A. Any Claim I May Have Against the Clubs is Not a Defense to Enforcement. The existence of any claim or cause of action I might have against the Clubs predicated on this Agreement or otherwise, will not constitute a defense to the enforcement by the Clubs or its clients or clients of this Agreement.

B. Enforcement of this Agreement by the Clubs is Necessary and Reasonable. I acknowledge and agree that the enforcement of this Agreement by the Clubs is necessary to ensure the preservation, protection and continuity of the business, clients, Confidential Information, and goodwill of the Clubs. I acknowledge and agree that the length and scope of the terms and restrictions contained in this Agreement are fair and reasonable and not the result of overreaching, duress or coercion of any kind. I further acknowledge and agree that my full, uninhibited and faithful observance of this Agreement will not cause me any undue hardship, financial or otherwise, and that enforcement of this Agreement will not impair my ability to obtain volunteerism commensurate with my abilities and on terms fully acceptable to me, or to otherwise obtain income required for the comfortable support of me and my family, and the satisfaction of the needs of my creditors.

C. Each Provision of this Agreement Can Be Read Independently and Can Be Enforced to the Fullest Extent Possible. I agree that if any provision of this Agreement is contrary to, prohibited by, or deemed invalid under, any applicable law, rule or regulation, such provision shall be inapplicable and deemed omitted to the extent so contrary, prohibited or invalid, but the remainder of this Agreement will not be so invalidated, and will be given full force and effect so far as possible. Furthermore, if any provision of this Agreement may be construed to have more than one meaning, and one meaning would make the provision invalid or otherwise voidable or unenforceable, while another meaning would make the provision valid and enforceable, the provision will have the meaning which makes it valid and enforceable.

D. Restrictions. In the event that any court finally holds that any of the restrictions or other provisions contained in this Agreement constitute an unreasonable restriction upon me, I agree that the provisions of this Agreement will not be rendered void, but will apply as to their time and territory or to such other extent as such court may judicially determine or indicate constitutes a reasonable restriction.

E. Equitable Relief. I acknowledge that damages at law would be an inadequate remedy for any breach or threatened breach of this Agreement by me. Therefore, in the event of a breach or threatened breach by me of this Agreement, the Clubs shall be entitled, in addition to all other rights or remedies, to an injunction restraining such breach, without being required to show any actual damage or to post an injunction bond, and/or a decree of specific performance, and/or any other equitable remedy.

6. Miscellaneous.

A. Only Written Amendments to this Agreement Are Permitted. I agree that the provisions of this Agreement may not be amended, supplemented, waived or changed orally, but only by a writing signed by both an authorized representative of the Clubs and me, and making specific reference to this Agreement.

B. Assignment of Rights and Obligations Under this Agreement. The Clubs may assign its rights and/or obligations pursuant to this Agreement without my prior written consent.

C. Jurisdiction and Venue For any Legal Action Will Be in Martin County, Florida. I acknowledge that a substantial portion of negotiations, anticipated performance and execution of this Agreement occurred or shall occur in Martin County, Florida, and that, therefore, I irrevocably and unconditionally (i) agree that any suit, action or legal proceeding arising out of or relating to this Agreement shall be brought in the courts of record of the State of Florida in Palm Beach County, or the court of the United States, Southern District of Florida, (ii) consent to the jurisdiction of each such court in any such suit, action or proceeding, (iii) waive any objection which I may have to the laying of venue of any such suit, action or proceeding in any of such courts, and (iv) agree that service of any court paper may be effected on any party in any manner as may be provided under applicable laws or court rules in said state.

D. This Agreement is Governed by the Laws of Florida. I agree that this Agreement will be governed by, and construed and enforced in accordance with, the laws of the State of Florida without regard for the principles of conflicts of law.

E. Headings in this Agreement are for Convenience Only. The headings contained in this Agreement are for convenience only. The headings are not considered a part of this Agreement and will not limit or affect in any way the meaning or interpretation of this Agreement.

F. Survival. All covenants, agreements, representations and warranties made by me in this Agreement or otherwise made by me in writing pursuant to this Agreement shall survive the execution and delivery of this Agreement and the expiration or termination of my volunteerism with the Clubs, for any reason or for no reason (and regardless of who is the terminating party).

G. Waivers. If the Clubs ever fails to require, or delays requiring, my performance of any provision of this Agreement, even if known, such failure or delay will not affect the Clubs’ right to require performance of that provision, or to exercise any of its rights, powers or remedies pursuant to this Agreement. Any waiver by the Clubs of any breach of any provision of this Agreement shall not be construed as a waiver of any continuing

or succeeding breach of such provision, a waiver of the provision itself, or a waiver of any right, power or remedy under this Agreement.

H. Remedies are Non-Exclusive and Cumulative. Each remedy provided to either the Clubs or me pursuant to this Agreement is intended not to be exclusive of any other remedy available to the Clubs or me pursuant to this Agreement and shall be in addition to every other remedy available to the Clubs or me. No single or partial exercise by either the Clubs or me of any right, power or remedy provided pursuant to this Agreement shall disallow or preclude any additional exercise of such right, power or remedy by such party.

I. Preparation of Agreement. This Agreement shall not be construed more strongly against the Clubs despite the Clubs’ responsibility for its preparation.

J. ADVICE OF COUNSEL. THE CLUBS AND I EACH ACKNOWLEDGE THAT IT HAS BEEN ADVISED BY ITS OWN COUNSEL WITH RESPECT TO THE TRANSACTION GOVERNED BY THIS AGREEMENT, AND SPECIFICALLY WITH RESPECT TO THE TERMS OF SECTION 6(K), WHICH CONCERNS THE WAIVER OF EACH PARTY'S RIGHT TO TRIAL BY JURY.

K. JURY WAIVER. IN ANY CIVIL ACTION, COUNTERCLAIM, OR PROCEEDING, WHETHER AT LAW OR IN EQUITY, WHICH ARISES OUT OF, CONCERNS, OR RELATES TO THIS AGREEMENT, OR THE RELATIONSHIP CREATED HEREBY, WHETHER SOUNDING IN CONTRACT, TORT, STRICT LIABILITY, OR OTHERWISE, TRIAL SHALL BE TO A COURT OF COMPETENT JURISDICTION AND NOT TO A JURY. THE CLUBS AND I EACH HEREBY IRREVOCABLY WAIVE ANY RIGHT WE MAY HAVE TO A TRIAL BY JURY. EITHER I OR THE CLUBS MAY FILE AN ORIGINAL COUNTERPART OR A COPY OF THIS AGREEMENT WITH ANY COURT, AS WRITTEN EVIDENCE OF THE CONSENT OF THE CLUBS AND I OF THE WAIVER OF EACH OF OUR RIGHTS TO TRIAL BY JURY. NEITHER THE CLUBS NOR I HAVE MADE OR RELIED UPON ANY ORAL REPRESENTATIONS TO OR BY ANY OTHER PARTY REGARDING THE ENFORCEABILITY OF THIS PROVISION. THE CLUBS AND I EACH HAVE READ AND UNDERSTAND THE EFFECT OF THIS JURY WAIVER PROVISION.

L. This Agreement Is Our Entire Understanding. This Agreement represents the entire understanding and agreement between the Clubs and me with respect to its subject matter and supersedes all other negotiations, understandings and representations (if any) made by and between the Clubs and me regarding the same. Nothing in this Agreement shall be construed as a contract for my volunteerism, or a guarantee of my volunteerism, with the Clubs.

Volunteer Signature

. Print Name Accepted by Boys & Girls Clubs of Martin County, Inc.

Signature Lindsay Gormley Print Name

Human Resource & Volunteer Director Title

This form is required

WAIVER AGREEMENT AND STATEMENT for Criminal History Record Checks

Pursuant to the National Child Protection Act of 1993, as amended, and section 943.0542, Florida Statutes, this

form must be completed and signed by every current or prospective employee, volunteer, and contractor/vendor, for whom criminal history records are requested by a qualified entity under these laws.

I hereby authorize Boys & Girls Clubs of Martin County (Qualified Entity) to request information from various Federal, State, and other agencies which maintain records concerning my past activities related to my driving, criminal, civil and other experiences. I understand that I would be able to receive any national criminal history record that may pertain to me directly from First Advantage Background Services Corp. ("First Advantage"), P.O. Box 105292, Atlanta, GA 30348,1-800-845-6004 and that I could then freely disclose any such information to whomever I chose. By signing this Waiver Agreement, it is my intent to authorize the dissemination of any national criminal history record that may pertain to me to the Qualified Entity with which I am or am seeking to be employed or to serve as a volunteer, pursuant to the National Child Protection Act of 1993, as amended, and Section 943.0542, Florida Statutes.

I understand that, until the criminal history background check is completed, you may choose to deny me unsupervised access to children, the elderly, or individuals with disabilities. I further understand that, upon request, you will provide me a copy of the criminal history background report, if any, you receive on me and that I am entitled to challenge the accuracy and completeness of any information contained in any such report. I may obtain a prompt determination as to the validity of my challenge before you make a final decision about my status as an employee, volunteer, contractor, or subcontractor. A national criminal history background check on me has previously been requested by: _____________________________________________________________________________ (Name and Address of Previous Qualified Entity) (Year of Request)

If the answer to either question is yes, please explain (state the date, type of crime, place of occurrence, disposition): ________________________________________________________________________________________________ ________________________________________________________________________________________________ I authorize you to release my criminal history records, if any, to other qualified entities. Yes No

Conviction of a crime will not necessarily disqualify you for a volunteer opportunity. Each conviction will be judged on its own merit with respect to time and volunteer relatedness. Signature: _____________________________________________________________________ Date: _______________________ Printed Name: ______________________________________________________________________________________________ Address: ___________________________________________________________________________________________________

TO BE COMPLETED BY QUALIFIED ENTITY:

Entity Name: Boys & Girls Clubs of Martin County Address: P.O. Box 910, Hobe Sound, Florida 33475

Telephone:772-545-1255 Fax:772-545-1204

ORIGINAL - MUST BE RETAINED BY QUALIFIED ENTITY

Have you ever been convicted/plead nolo contendere to a crime or had adjudication withheld?

Yes

No

Are you currently awaiting trial, sentencing or other disposition of a criminal charge? Yes No

This form and the following form are required.

Prior States: refers only to states where you have lived during the past 5 years, other than Florida

This form is required

Read and Keep these next 2 pages for your personal files